3. What to do: Response options

The prevention and treatment of HIV/AIDS must be approached from a multi-sectoral perspective in an emergency response. Section 3.1 provides an outline on how this may be achieved.

The following recommendations are adapted from the 2004 IASC’s Guidelines for HIV/AIDS  interventions in emergency settings (Note: these guidelines are under revision and the final version is expected in May 2009, check the following website for updates, http://www.aidsandemergencies.org/cms/index.php?option=com_content&task=view&id=17&Itemid=34)

Sectoral response Emergency preparedness Minimum response (to be conducted even in the middle of an emergency) Comprehensive response(Stabilised phase)



  • Determine coordination structures, including the presence of a Health Cluster.
  • Identify and list partners (including local government).
  • Establish network of resource persons.
  • Raise funds.
  • Prepare contingency plans.
  • Include HIV/AIDS in humanitarian action plans and train relief workers accordingly.
  • Coordinate response through the Health Cluster, if present in-country.  If not, establish coordination mechanism.
  • Continue fundraising.
  • Strengthen networks.
  • Enhance information sharing.
  • Build human capacity.
  • Link emergency to development HIV action.
  • Work with authorities.
  • Assist government and non-state entities to promote and protect human rights.
Assessment and monitoring
  • Conduct capacity and situation analysis.
  • Develop indicators and tools, or use existing tools as appropriate (i.e. MISP, Health Cluster’s IRA and HeRAMs tools).
  • Involve local institutions and beneficiaries.
  • Assess baseline data.
  • Maintain database.
  • Set up and manage a shared database.
  • Monitor and evaluate all programmes.
  • Assess data on prevalence, knowledge, attitudes and practice, and impact of HIV/AIDS.
  • Monitor activities.
  • Draw lessons from evaluations.
  • Review existing protection laws and policies.
  • Promote human rights and best practices.
  • Ensure that humanitarian activities minimise the risk of sexual violence and exploitation, and HIV-related discrimination.
  • Train uniformed forces and humanitarian workers on HIV/AIDS and sexual violence.
  • Prevent and respond to sexual violence and exploitation.
  • Involve authorities to reduce HIV-related discrimination.
  • Protect orphans and separated children.
  • Expand prevention and response to sexual violence and exploitation.
  • Strengthen protection for orphans, separated children and young people.
  • Ensure access to condoms for peacekeepers, and military and humanitarian staff.
  • Institutionalise training for uniformed forces on HIV/AIDS, sexual violence and exploitation, and non-discrimination.
  • Put in place HIV-related services for demobilised personnel.
  • Strengthen IDP/refugee response.
  • Provide (or refer) post-exposure prophylaxis (PEP)
  • (Refer also to Chapter 8.5 Health)
Water and sanitation
  • Train staff on HIV/AIDS, sexual violence, gender and non-discrimination.
  • Include HIV considerations in water/ sanitation planning.
  • Establish water/sanitation management committees.
  • Organise awareness campaigns on hygiene and sanitation, and target people affected by HIV.
Food security and nutrition
  • Undertake contingency planning/preposition supplies.
  • Train staff on special needs of HIV/AIDS-affected populations.
  • Include information about nutritional care and support of PLWHA in community nutrition education programmes.
  • Support food security of HIV/AIDS-affected households.
  • Target food aid to affected and at-risk households and communities.
  • Plan nutrition and food needs for populations with high HIV prevalence.
  • Promote appropriate care and feeding practices for PLWHA.
  • Support and protect food security of HIV/AIDS-affected and at-risk households and communities.
  • Distribute food aid to affected households and communities.
  • Develop strategies to protect long-term food security of HIV-affected people.
  • Develop strategies and target vulnerable groups for agricultural extension programmes.
  • Collaborate with community and home-based care programmes to provide nutritional support.
  • Assist the government to fulfil its obligation to respect the human right to food.
Shelter and site planning
  • Ensure safety of potential sites.
  • Train staff on HIV/AIDS, gender and non-discrimination.
  • Establish safely designed sites.
  • Plan the orderly movement of displaced persons.
  • Map current services and practices.
  • Plan and stock medical and reproductive health (RH) supplies.
  • Adapt/develop protocols.
  • Train health personnel.
  • Plan quality assurance mechanisms.
  • Train staff on the issue of sexual and GBV and the link with HIV/AIDS.
  • Determine prevalence of injecting drug use.
  • ¨ Develop instruction leaflets on cleaning injecting materials.
  • Map and support prevention and care initiatives.
  • Train staff and peer educators.
  • Train health staff on RH issues linked with emergencies and the use of RH kits.
  • Assess current practices in the application of universal precautions.
  • Ensure access to basic health care for the most vulnerable.
  • Ensure a safe blood supply.
  • Provide male and female condoms.
  • Institute syndromic STI treatment.
  • Continue ARV treatment as soon as possible for those already on ARVs
  • Ensure Intravenous Drug User (IDU) appropriate care.
  • Manage the consequences of sexual violence.
  • Ensure safe deliveries.
  • Raise awareness of prevention and treatment services for STIs/HIV.
  • Ensure adherence to universal precautions.
  • Forecast longer-term needs: secure regular supplies and ensure appropriate training of the staff.
  • Provide palliative care and home-based care.
  • Treatment of opportunistic infections and tuberculosis control programmes.
  • Provide anti-retroviral (ARV) treatment.
  • Ensure safe blood transfusion services.
  • Provide family planning services and continue to provide condoms.
  • Manage STI, including condoms.
  • Provide comprehensive sexual violence programmes.
  • Control drug trafficking in camp settings.
  • Use peer educators to provide counselling and education on risk reduction strategies.
  • Provide voluntary counselling and testing.
  • Provide reproductive health services for young people.
  • Prevent mother-to-child transmission.
  • Enable/monitor/reinforce universal precautions in health care.
  • Determine emergency education options for boys and girls.
  • Train teachers on HIV/AIDS, and sexual violence and exploitation.
  • Ensure children’s access to education.
  • Educate girls and boys (formal and non-formal).
  • Provide life skills-based HIV/AIDS education.
  • Monitor and respond to sexual violence and exploitation in educational settings.
Behaviour change
communicationand information education
  • Prepare culturally appropriate messages in local languages.
  • Prepare a basic Behaviour Change Communication/ Information, Education Communication (BCC/IEC) strategy.
  • Involve key beneficiaries.
  • Conduct awareness campaigns.
  • Store key documents outside potential emergency areas.
  • Provide information on HIV/AIDS prevention and care.
  • Scale-up BCC/IEC.
  • Monitor and evaluate activities.
HIV/AIDS in theworkplace
  • Review personnel policies regarding the management of People Living with HIV/AIDS (PLWHA) who work in humanitarian operations.
  • Develop policies when there are none, aimed at minimising the potential for discrimination.
  • Stock materials for PEP.
  • Prevent discrimination by HIV status in staff management.
  • Build capacity of supporting groups for PLWHA and their families.
  • Establish workplace policies to eliminate discrimination against PLWHA.
  • Provide PEP for humanitarian staff.
  • Provide PEP for all humanitarian workers on a regular basis.

Source: IASC 2004. Guidelines for HIV/AIDS interventions in emergency settings.

In Malawi, HIV/AIDS has increased affected communities’ vulnerabilities to food crises and other emergencies due to reduced labor capacity, increased food insecurity, increased expenditure needs and reduced social capital due to stigma. CARE’s SMIHLE (Supporting and Mitigating the Impact of HIV/AIDS for Livelihood Enhancement) project aims to strengthen food and income security within the context of HIV/AIDS. The programme targets the most vulnerable households-especially female or child-headed, households that have taken in OVC (Orphans and other vulnerable children) and those caring for chronically ill people. Working with community-based organisations, the programme reaches 30,000 households (420,000 people) and 165,000 secondary beneficiaries in six traditional authorities in Lilongwe and Dowa.

SMIHLE’s main activities focus on improving livelihoods and mitigating the impact of HIV/AIDS through agriculture support and seed multiplication, marketing, VS&L (Voluntary savings and loans), natural resource management interventions, and through building the capacity of village-based coordinating structures. The SMIHLE project has been successful in raising the standard of living for rural communities through improved food security and increased income, which makes affected communities less vulnerable to food shortages and other emergencies.